我国医院产权制度改革实践分析

从我国医院产权制度改革的现实出发，分析了医院产权制度改革的背景，描述了医院产权制度改革的发展阶段和改革的主要形式，对医院产权 制度改革的客观必然性做了初步分析。指出卫生行政部门应积极介入医院产权制度改革，既要支持改革形式的多样性，又要依据医疗服务的特殊性，适时加以规范、引导，维护医疗服务的总体社会目标。     

医院改革的新机遇和新课题：职工医疗制度改革对医院的影响

结合我国职工医疗制度改革试点的实践,从医院的补偿、医院的发展和医院的经营目标三个方面论述了职工医疗制度改革对医院的影响。指出医院适应职工医疗保障制度改革是适应社会主义市场经济的具体化,医院要增强竞争意识,强化成本核算,提高服务质量,研究医疗需求态势,避免盲目发展。医院应取的经营目标是在确保基本医疗服务的前提下,正确引导合理健康的医疗消费,满足不同层次的医疗需求。     

县乡级医疗机构产权制度改革初探

分析县乡级医疗机构的性质 ,功能及存在的主要问题 ,指出了医院产权制度改革的必要性和必然性 ,并分析了目前医院产权制度改革所采取的股份制、股份合作制、内部职工持股、组建医疗服务集团、拍卖转让等具体形式 ,同时也指出实行医院产权制度改革存在的主要问题 ,提出了医院产权制度改革措施和注意事项。     

县级医院能力建设是关键

卫生部医改办公立医院改革组组长、医疗服务监管司副司长孙阳近日在接受记者采访时指出,县级医院率先推进改革,可以为整体推进公立医院改革发展探索和积累宝贵的经验,通过提高县级医院的能力和医疗服务水平,可以分流患者,缓解大城市、大医院的压力,为城市大医院的改革创造条件。再者,通过发挥在县域医疗体系中的龙头作用,县级医院还起到带动乡村医疗卫生协同发展、提高医疗体系整体效率的作用,从而夯实基层医疗卫生机构综合改革的成效。     

特需医疗服务的界定与质疑

随着我国社会主义市场经济体制的建立和医院改革的不断深化,医疗服务为尽快适应社会主义市场经济的需求,建立起新型医疗服务运行机制,医院出现了特需医疗服务这一医疗服务改革新举措。几年来,各地、各医院特需医疗服务开展不均衡,特需医疗服务的立项也不尽规范,有的特需医疗服务已出现明显弊端。为了使我国医疗卫生事业改革不断深入地进行,有必要对目前开展的特需医疗服务进行界定和评价,使我国的医疗卫生事业在正确的导向下健康地发展。     

医院开展多层次医疗服务的思考

党中央、国务院在关于卫生改革与发展决定中明确指出,以提高人民健康水平为中心,优先发展和保证基本卫生服务,逐步满足人民群众多样化的需求,并具体指出了基本医疗服务、非基本医疗和特需服务三种服务价格的作价原则。本文着重分析上海市三个层次医疗服务供求关系,提出医院开展多层次医疗服务的几点建议。1现有的医疗服务模式运行状况基本医疗服务方面。上海进行了医疗保险制度改革,相继推出的一系列医疗保险政策,使上海市民的基本医疗需求得到了基本保障。卫生统计资料显示,近年来,上海市医疗机构就诊总人数呈较明显下降趋势,并…     

英国一个典型医院集团化发展的分析

对英国一家医院托拉斯的改革方案和成效进行介绍与分析，指出医院集团发展的国际趋势和面临的现实困难，结合国内医疗改革实际情况，强调采用资本运营方式多方筹集资金，以实现各种战略联合组建医疗集团的必要性，在此基础上医院集团应通过提供各种层次的卫生服务占领医疗市场，以确保在越来越激烈的医疗服务竞争中立于不败之地。     

试析大型综合医院在社区医疗服务中的作用

根据国家城市卫生服务体系改革的原则及对基层医院和大医院的功能定位,分析大型综合医院在社区医疗服务中的作用。指出大型综合医院应加强与城市基层医院的联系,建立全科医生培训基地,为社区医疗服务输送适用人才,建立切实可行的转诊制度,成为社区医疗服务的坚强后盾,提高社区医疗服务的质量和水平,促进社区医疗服务的发展。     

浅论政府在医疗体制改革中的职能转变

对医疗市场的管理方—政府的重新定位、职能转换进行研究,指出应该通过政府主导型的医疗市场体制对医院进行宏观管理。研究结果为我国正在逐步推进的“三医联动”改革提供了有益的思路,也为政府、医院提高管理运行效能,更好保障医疗服务的公平和效率提供了理论依据。     

浅议医疗收费与医德及医院改革之关系

医疗收费活动是由医疗服务、经济与道德等多种因素组成的一个有机的过程,是医院在改革发展中需要不断探索, 社会群众较为关心的问题。本文试围绕医疗收费与医德及医院改革的关系做一探讨。一、医疗收费与医德之间的关系随着医院改革的不断深入,干部职工、医务人员的医务道德观念、道德行为也随之变化,提高了医疗服务水平,使医院变得更有生机,推动着医疗卫生事业的发展。但也必须指出,在发展的总趋势中,由于多方面原因,也存在一些问题。若不及时正确引导和解决,会出现医德滑坡、医疗质量     

当前医疗纠纷对医务人员态度行为影响的调查分析

通过对５８２位各级各类医务人员及行政管理人员问卷调查,分析研究当前医疗纠纷对医务人员的态度行为影响,反映出现医疗纠纷处理办法不能适应当前形势和要求,必然健全卫生法规法律制度,设立卫生法庭,探索医疗风险保险制度。     

病人权利,义务在医疗实践中的保证

论述了病人权利和医疗法律法规中的地位,归纳了病人权利,义务的基本内容。在此基础提出了病人权利,义务在医疗实践中保证的措施,指出：医疗管理人员工作者要学习法律法规,医疗机构要建立必要可行的制度,使病人充分享有权利,履行应尽义务;医务人员要给予就医者足够的医疗信息,使其具有选择医疗方式的权利;在医疗实践中还应尽量满足就医者的特需请求。     

1992～1997年中国医疗费用测算结果和概略分析

中国卫生总费用核算工作组运用实际使用法测算中国１９９２年医疗总费用作出阶段性研究结果，发表研究结果和初步分析报告（见本刊２０００年第１期）。现在，继续发表核算工作组对１９９７年医疗总费用的测算结果，并与１９９２年测算结果进行初步比较分析。     

北京市某区国际医疗服务机构经营现状分析

随着我国经济的发展和越来越多的外籍人士及海外华人来华旅游、工作或定居,国际医疗服务的需求也越来越多.北京、上海、广州等地区因外籍人员较多,对于优质的国际医疗服务需求与日俱增.文章分析了北京市国际医疗服务区内的5所国际医疗服务机构经营现状,深度剖析其面临的问题,并据此提出思考和建议:一是相对于某区国际医疗服务机构不完善情...     

Between a rock and a hard place: the question of money at St. Petersburg women's clinics.

The new financing mechanisms introduced into the Russian health care system since the beginning of the 1990s have not resolved its severe financial problems. This article examines the consequences for outpatient services and the daily work of individual doctors in St. Petersburg, using women's reproductive health services as a case example. Interview and observational data reveal a constant opposition between formal rules and informal practices at both the administrative and polyclinic levels. Polyclinics for women's reproductive health services have developed various strategies as a response to insufficient financing, but many of these strategies are questionable within the current mandatory health insurance system. Ordinary doctors perceive the development as mainly negative. The results raise the question of increasing arbitrariness, from patients' perspective, in the health services provided. The study illustrates how in a post-socialist context, the past constantly permeates the present in the form of novel adaptations to the new social context.     

Doctors and management--the development dilemma

Identifies managerial knowledge and skills from undergraduate to medical director level and considers the development of a core management training strategy and development programme, transferable on a national basis. Reports on a questionnaire survey plus in-depth interviews with doctors and senior managers divided between grades covering hospitals, general practices and public health services. Explains that the model evolved is a synthesis of managerial models set in the context of doctors' work. Concludes that doctors agreed that more support and training from their organizations would have been useful, and that managers were generally supportive of doctors becoming involved in management, although some harboured doubts about their willingness or the effects such moves would have on established management career structures. Contends that there appears to be a 30:70 split between doctors receptive to the concept of management and those against.     

关于建立医院重症监护技术协作网络的实践与思考

随着医学科学的发展,重症技术协作网络的建立越来越显得重要。文章介绍了重症监护技术网络的组织系统,协作的内容及其动作;组织全院性学术活动;组织监护查房;组织危重病人的科间护理会诊;协调专科特护小组;实施定点向轮转培训。指出今后应着眼于进一步完善重症监护技术协作网络实施方案,拓宽技术网络的协作范围,丰富监护技术协作内容,加强技术协作中心建设。     

Law, bioethics and practice in France: forging a new legislative pact

In France, bioethics norms have emerged in close interaction with medical practices. The first bioethics laws were adopted in 1994, with provisions for updates in 2004 and most recently, in 2011. As in other countries, bioethics laws indirectly refer to certain fundamental values. The purpose of this paper is threefold. First, I shall briefly describe the construction of the French bioethics laws and the values they are meant to protect. Secondly, I will show that the practice of clinical ethics, as reported in a few studies on ART, living organ donation and PGD, challenge the role attributed to doctors as “gatekeepers” of those fundamental values. Thirdly, I will suggest that the quality of medical practices would improve if the law focused on strengthening the tacit pact between doctors and patients, rather than putting doctors in charge of enforcing societal values. Doctors, for their part, would limit their role to what they can do best: provide sufficient patient support and safe care. Against those who argue that we should dispense with bioethics laws altogether, I hold that the laws are useful in order to limit the development of abusive practices. However, a new legislative approach should be adopted which would a positive presumption in favor of patients’ requests.     

上海市外国医师执业现状分析

目的初步掌握外国医师在上海市执业现状,为进一步做好全市外国医师执业监管工作提供依据。方法搜集、分析上海市外国医师执业数据和日常监管工作中外国医师对中国法津、法规的知晓程度。结果现有171位来自17个国家或地区的外国医师在中国执业;有80．70％的外国医师使用英语执业;服务对象多为外籍人士（70．18％）,其次是中国人（24．56％）和台湾人（5．26％）;他们对中国的《外国医师来华短期行医暂行管理办法》比较了解,而对其他相关法律、法规了解程度较差。结论外国医师在上海市执业人数不断增加,整体执业情况良好,但仍应完善外国医师来华行医的有关法律法规并根据现状进一步明确细化准入及执业的有关规定。     

Linking assessment to learning: a new route to quality assurance in medical practice

BACKGROUND: If continuing professional development is to work and be sensible, an understanding of clinical practice is needed, based on the daily experiences of doctors within the multiple factors that determine the nature and quality of practice. Moreover, there must be a way to link performance and assessment to ensure that ongoing learning and continuing competence are, in reality, connected. Current understanding of learning no longer holds that a doctor enters practice thoroughly trained with a lifetime's storehouse of knowledge. Rather a doctor's ongoing learning is a 'journey' across a practice lifetime, which involves the doctor as a person, interacting with their patients, other health professionals and the larger societal and community issues. OBJECTIVES: In this paper, we describe a model of learning and practice that proposes how change occurs, and how assessment links practice performance and learning. We describe how doctors define desired performance, compare actual with desired performance, define educational need and initiate educational action. METHOD: To illustrate the model, we describe how doctor performance varies over time for any one condition, and across conditions. We discuss how doctors perceive and respond to these variations in their performance. The model is also used to illustrate different formative and summative approaches to assessment, and to highlight the aspects of performance these can assess. CONCLUSIONS: We conclude by exploring the implications of this model for integrated medical services, highlighting the actions and directions that would be required of doctors, medical and professional organisations, universities and other continuing education providers, credentialling bodies and governments.